An assessment of the staffing level required for a high‐dependency unit

Abstract

SummaryHigh-dependency units are increasing in number and becoming an ever more important part of a hospital's facilities. The optimum staf®ng ratio is unknown, but the Department of Health and the Intensive Care Society recommend a level of one nurse to two patients. We recorded Therapeutic Intervention Scoring System-28 scores and Nurse Dependency Scores for all admissions to our adult, general high-dependency unit over 7 months. We found a weak correlation between the nurse dependency score and the Therapeutic Intervention Scoring System-28 score. The median Therapeutic Intervention Scoring System-28 score was 23 points (interquartile range 19±26), and the median Nurse Dependency Score was 1.0. These results are approximately two-thirds of those for European intensive care units. We conclude that a nurse-to-patient ratio of 1 : 2 may be insuf®cient for an adult general high-dependency unit, and would recommend a nurse-to-patient ratio of 2 : 3.

Demand for Nursing Care for Patients in Intensive Care Units in Southeast Poland

“…26,[28][29][30][31][32] The mean age of patients hospitalized in type 2 and 3 ICUs in Poland was similar to the lower value of 52, whereas the mean age of patients in type 1 ICUs (61.32 years) was similar to the higher value.…”

“…In Western Europe and the United States, mean ICU length of stay is 1 to 78 days. 26,28,[30][31][32][33] The greatest mean ICU length of stay in the hospitals in our study, nearly 34 days, occurred in type 3 ICUs, ones where advanced and complicated procedures are performed. Mean ICU length of stay was 20 days in type 2 (voivodeship) hospitals and no more than 8 days in type 1 (poviat) hospitals, where basic procedures are performed.…”

“…Scores on the TISS-28 do not fully reflect activities such as indirect nursing time, organizational tasks, or work breaks. 4,5,28,36 TISS-28 scores also do not reflect activities within the scope of teaching/managing, encouraging/supporting, or being present in patients' rooms, all of which are provided in Polish ICUs. 37 Thus, the scores reflect only a fraction of such activities, which can account for 32% of a nurse's time.…”

Intermediate care units

“…It was also shown that using a TISS-28 of on average 23 and a nursing dependency score of on average 1.0, cover of at least 1:2 would have been required [27].…”

The Impact of an ICU Liaison Nurse on Discharge Delay in Patients after Prolonged ICU Stay

“…The factors that impact on ICU bed availability are varied. Staffi ng 9,17,19 , admission and discharge decisions 2,9,20,17,14,21 , open versus closed ICUs 22,23 , seasonal peaks in ICU bed demand and the presence of high dependency units (HDUs) 24,25,26 potentially infl uence occupancy rates. While premature discharge has received some attention 2,9,10,11 , one factor that is rarely considered in the study of occupancy rates is the impact of discharge delay time on subsequent ICU bed availability.…”